Elsevier

Epilepsy & Behavior

Volume 61, August 2016, Pages 102-106
Epilepsy & Behavior

Self-concept and gender effects in Korean adolescents with epilepsy

https://doi.org/10.1016/j.yebeh.2016.05.016Get rights and content

Highlights

  • Adolescents with epilepsy had lower self-concept, especially in behavioral conduct and social acceptance, than controls.

  • Sex difference in social acceptance was identified in controls but not in group with epilepsy.

  • A group-by-sex interaction effect was found on social acceptance.

  • Physical appearance was negatively correlated with anxiety in girls with epilepsy.

Abstract

Purpose

We aimed to determine whether adolescents with epilepsy (AWE) have a compromised self-concept, whether a lower self-concept is related to mental health, and whether there are sex differences in self-concept in AWE.

Methods

A total of 179 AWE and 259 control adolescents without epilepsy participated in this cross-sectional, multicenter study. Self-concept was measured using the Harter's Self-Perception Profile for Children. Depressive symptoms and anxiety were assessed by the Hospital Anxiety Depression Scale (HADS). A group-by-sex interaction was evaluated using an analysis of covariance controlling for age.

Results

Adolescents with epilepsy had a lower level of self-concept, especially in domains of behavioral conduct (partial eta2: 0.257) and social acceptance (partial eta2: 0.116), than controls (p < 0.05). The level of self-concept did not differ by sex in the group with epilepsy. A group-by-sex interaction effect was found on social acceptance (p = 0.042). Unlike the control group, age was not correlated with self-concept in AWE. Physical appearance was negatively correlated with HADS-anxiety scores (r =  0.291, p < 0.01) but only in girls with epilepsy. Epilepsy duration was correlated with social acceptance in boys (r = 0.211, p < 0.05) and physical appearance in girls (r =  0.249, p < 0.05).

Conclusions

Adolescents with epilepsy had a lower level of self-concept, especially in the domains of behavioral conduct and social acceptance, than controls. Sex differences in self-concept were identified in the control group but not in the group with epilepsy. Physical appearance was negatively correlated with anxiety in girls with epilepsy.

Introduction

Epilepsy is one of the most common neurological disorders. The psychological well-being of people with epilepsy could be influenced by the stigmatizing nature of epilepsy, the unpredictability of seizures, and cognitive problems occurring in these patients [1], [2], [3], [4], [5]. Self-concept is a multidimensional psychological construct that is defined as an individual's internal interpretation of their social acceptance, athletic and scholastic abilities, behavior, and physical appearance [6]. Given that adolescence is a critical period of life for developing self-identity and peer relationships, recurrent seizures in adolescents with epilepsy (AWE) could greatly compromise their self-concept, which is comprised of individuals' perceived identity and evaluation of their characteristics relative to others [6].

Recently, Ferro et al. [7] reviewed the studies on self-concept in AWE. Although self-concept in AWE in most reports appeared to be lower than in adolescents without epilepsy, a meta-analysis that pooled the studies unexpectedly failed to show that AWE had a lower self-concept than those without epilepsy [7]. These negative findings were explained by the meta-analysis being composed of few studies involving relatively small samples and of limited quality [7]. Given that an improved self-concept is associated with lower levels of distress and higher levels of coping [8], self-concept may be important to increase resilience to social challenges from chronic disease [9], particularly in AWE. Therefore, further studies with a large sample size are needed to clarify whether AWE have poorer self-concept than adolescents without epilepsy. In addition, it is necessary to determine whether poor self-concept is associated with mental health problems in AWE.

Self-concept in normally developing children differs depending on their sex and age [10], [11]. Self-concept may decrease during the transition from childhood to early adolescence [11] and may differ between boys and girls [12]. In general, boys rate themselves significantly higher on the global self-concept than do girls [10], [12]. However, such age and sex differences in self-concept have not been well studied in an AWE population.

The aims of our present study were (1) to determine whether AWE cases have a compromised self-concept compared with adolescents without epilepsy, (2) to investigate potential relationships between self-concept and depressive symptoms and anxiety in AWE, and (3) to investigate potential sex differences in self-concept in AWE.

Section snippets

Subjects

This was a cross-sectional, multicenter study involving 17 secondary or tertiary hospitals in Korea. To be eligible, subjects had to meet the following inclusion criteria: middle or high school students aged 13–18 years, being diagnosed with epilepsy, being treated with antiepileptic drugs for at least one year, and willing to complete self-reported questionnaires. Epilepsy was defined as a history of two or more unprovoked seizures. Subjects with a single seizure were also included if they had

Age-related differences in self-concept

In boys without epilepsy, age was negatively correlated with the scores of scholastic competence, physical appearance, and behavioral conduct (all p values < 0.01) (Table 2) while girls without epilepsy did not show such correlations. Scores of social acceptance, athletic competence, and global self-worth did not relate to age in both boys and girls without epilepsy. In both boys and girls with epilepsy, age was not correlated with any domains of self-concept (Table 2).

Comparison of self-concept between adolescents with and without epilepsy

Based on the ANCOVA after

Discussion

Hypothesizing that AWE may have a compromised self-concept is reasonable because of the stigmatizing nature of epilepsy. In our present study, as expected, AWE had a lower level of self-concept, especially in the domains of behavioral conduct and social acceptance, than the control group. Although differences in mean scores of athletic competence, physical appearance, and global self-worth were statistically significant between adolescents with and without epilepsy, effect sizes were too small

Acknowledgments

The study was financially supported by a grant from Korea UCB Co., Limited.

Conflicts of interest

The authors declare no conflicts of interest in relation to this study.

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